Brit J Anaesth :非心脏手术患者术中低血压与持续性急性肾病相关

2022-05-18 MedSci原创 MedSci原创

术中低血压与持续性而非迟发性急性肾脏疾病相关。这两种急性肾病似乎都与增加的医疗保健利用水平相关。纠正术中低血压是减少术后肾损伤和降低相关费用的潜在措施。

围手术期急性肾损伤在手术患者中很常见。它在接受重大非心脏手术的患者中很常见,发生率为6.3-13.4%,也是患者发病和死亡的主要原因。虽然术中低血压与术后急性肾损伤有关,但术中低血压与急性肾脏疾病之间的联系尚未明确。

近日,麻醉疼痛领域权威杂志British Journal of Anaesthesia上发表了一篇研究文章,研究人员利用从美国电子健康记录数据库中提取的非心脏、非产科手术数据进行了一项回顾性多中心队列研究。

该研究的主要观察性结局是根据三个平均动脉压(MAP)阈值(≤75、≤65和≤55mmhg)来定义的术中低血压与以下两个急性肾脏疾病亚型之间的相关性:(i)持续性(术后7天内发生的急性肾损伤,术后8至90天持续存在)和(ii)迟发性(7天内未发生急性肾损伤的肾损害,术后8至90天发生急性肾损伤)。该研究的次要结局包括急性肾脏疾病亚型或无急性肾脏疾病患者的医疗资源利用情况。

该研究共有112912名手术患者符合纳入标准。研究人员观察到迟发性急性肾脏疾病为2.2%,持续性急性肾脏疾病为0.6%。术中低血压与持续急性肾脏疾病显著相关,MAP≤55mmhg(风险比为1.1;95%置信区间:1.38~1.22;P<0.004)。然而,对于任何MAP阈值的术中低血压与延迟急性肾脏疾病均无显著相关性。与没有急性肾脏疾病的患者相比,延迟或持续性急性肾脏疾病患者在医院和重症监护住院期间的医疗资源利用率更高。

由此可见,术中低血压与持续性而非迟发性急性肾脏疾病相关。这两种急性肾病似乎都与增加的医疗保健利用水平相关。纠正术中低血压是减少术后肾损伤和降低相关费用的潜在措施。

原始出处:

Andrew D. Shaw.et al.Intraoperative hypotension is associated with persistent acute kidney disease after noncardiac surgery: a multicentre cohort study.British Journal of Anaesthesia.2022.https://www.bjanaesthesia.org/article/S0007-0912(22)00157-X/fulltext

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  4. [GetPortalCommentsPageByObjectIdResponse(id=2051779, encodeId=3ac12051e79fd, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Thu Aug 18 23:40:12 CST 2022, time=2022-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1922637, encodeId=1c25192263e82, content=<a href='/topic/show?id=3f3156324ff' target=_blank style='color:#2F92EE;'>#持续性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56324, encryptionId=3f3156324ff, topicName=持续性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2c31495, createdName=liuyg0228, createdTime=Wed Jan 04 09:40:12 CST 2023, time=2023-01-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1819311, encodeId=7b561819311a1, content=<a href='/topic/show?id=aba89940943' target=_blank style='color:#2F92EE;'>#非心脏#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99409, encryptionId=aba89940943, topicName=非心脏)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=917c196, createdName=sjzlzc007, createdTime=Sat Aug 06 14:40:12 CST 2022, time=2022-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1633639, encodeId=02af16336392c, content=<a href='/topic/show?id=377824e1c0' target=_blank style='color:#2F92EE;'>#ANA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2471, encryptionId=377824e1c0, topicName=ANA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=434d22047430, createdName=AspirantSuo, createdTime=Fri Jul 01 14:40:12 CST 2022, time=2022-07-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1224203, encodeId=1d7012242038b, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220424/d1a02915c1074376b5d24f9bebd99767/33e8a532f6b94a6b8cef81d5e81e391b.jpg, createdBy=5ef76425265, createdName=2022.4, createdTime=Fri Jun 03 08:25:32 CST 2022, time=2022-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1367432, encodeId=c8f5136e43229, content=<a href='/topic/show?id=f4012634656' target=_blank style='color:#2F92EE;'>#低血压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26346, encryptionId=f4012634656, topicName=低血压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f634250, createdName=chentianping, createdTime=Fri May 20 06:40:12 CST 2022, time=2022-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1488308, encodeId=da8c148830845, content=<a href='/topic/show?id=f37799413a6' target=_blank style='color:#2F92EE;'>#非心脏手术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99413, encryptionId=f37799413a6, topicName=非心脏手术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b5438409695, createdName=bnurmamat, createdTime=Fri May 20 06:40:12 CST 2022, time=2022-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1525775, encodeId=d2a71525e7595, content=<a href='/topic/show?id=354660966b1' target=_blank style='color:#2F92EE;'>#术中低血压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=60966, encryptionId=354660966b1, topicName=术中低血压)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=xinxin088, createdTime=Fri May 20 06:40:12 CST 2022, time=2022-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220776, encodeId=dbcc1220e76f1, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Wed May 18 22:21:48 CST 2022, time=2022-05-18, status=1, ipAttribution=)]
    2022-07-01 AspirantSuo
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    2022-06-03 2022.4

    学习了

    0

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    2022-05-18 1209e435m98(暂无昵称)

    学习了,谢谢分享

    0

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欧美同期发布新版非心脏手术患者围术期心血管评估和管理指南

8月1日,美国心脏病学会(ACC)/美国心脏学会(AHA)发布了《2014 ACC/AHA非心脏手术患者围术期心血管评估和管理指南》,全文在线发表于《美国心脏病学杂志》(J Am Coll Cardiol)和《循环》(Circulation)杂志。同期,《欧洲心脏杂志》(Eur Heart J)在线发表了欧洲心脏病学会/欧洲麻醉学会(ESC/ESA)发布的《2014 ESC/ESA非心脏手术指南:

郭艺芳:解读非心脏手术围术期心血管评估与管理指南

8月1日,《循环》(Circulation)杂志在线发布了2014年《ACC/AHA非心脏手术患者围术期心血管评估和管理指南》及执行摘要、《2014ACC/AHA系统回顾:β阻滞剂在非心脏手术围术期患者中的应用》。指南下载:欧美同期发布新版非心脏手术患者围术期心血管评估和管理指南 郭艺芳教授对ACC/AHA非心脏手术患者围术期心血管评估和管理指南进行了解读,以下为详细内容。

Circulation:近两成非心脏手术患者会发生围术期心肌损伤

Circulation杂志发表研究表明,16%的非心脏手术患者发生围手术期心肌损伤。